In an industry that strives to help people improve health and fitness, there is still a significant amount of judgment and stigma toward people with obesity. A 2018 literature review found that weight bias was “pervasive” among health, fitness and nutrition professionals (Panza et al. 2018). Stigma and weight bias can negatively affect client outcomes and may even worsen mental health struggles and cause weight gain, the exact issues we are hoping to combat as health and fitness coaches.
Continuing to focus on ideal body types, strict diets and cut abs is not going to improve the health of the general population. Research shows that underlying biases are harmful and can worsen health outcomes in those who feel they are being judged. Specifically, weight stigma is associated with “obesity, diabetes risk, cortisol level, oxidative stress level, C-reactive protein level, eating disturbances, depression, anxiety [and] body image dissatisfaction and negatively associated with self-esteem among overweight and obese adults” (Wu & Berry 2018).
John Berardi, PhD, co-founder of Precision Nutrition, summed up weight bias in the industry in Change Maker, his recent book for health and fitness pros: “When I looked around, I saw a big disconnect between the people working in health and fitness and the people we were supposed to be helping. It seemed as if the entire field was set up to cater exclusively to people like me and my fellow fit friends. . . . We were putting all of our energy into serving a tiny percent of the population, the small segment of people who, ironically, needed our help the least” (Berardi 2019).
Shifting Our Own Perceptions
Considering that 42% of adults in the United States have obesity and many of the leading causes of death are due to preventable, lifestyle-related chronic diseases (CDC 2020), it’s time for the health and fitness industry to take a stand as a partner in improving health outcomes for all populations. This starts with understanding and combating the industry’s underlying weight stigma. With childhood obesity becoming even more prevalent, it’s estimated that half of the U.S. population will have obesity or be considered overweight by the year 2030, only one decade from now (Ward et al. 2019).
We need a paradigm shift in how we approach health and well-being. Our task is to destigmatize an industry that has focused on chasing a body ideal, glamorizing weight loss, and fixating on thin and muscular body types. Health and fitness coaches have the tools that can increase health, life expectancy and quality of life, but these tools are ineffective if we are saving them for people who are already healthy, while actively discriminating against those who may need the most support.
The health and fitness industry can begin to make changes to address weight bias and promote inclusivity by
- acknowledging weight bias and identifying and working to change personal biases
- understanding the complexity of the underlying causes of obesity and having empathy for all clients
- understanding how to effectively coach clients with obesity in a helpful and positive manner
- using inclusive messaging from the industry as a whole
What Is Weight Bias?
The Rudd Center for Food Policy and Obesity states, “People who have a higher body weight are vulnerable to stereotypes, bias, bullying, and discrimination in our society” (The Rudd Center 2020), adding that weight bias includes any underlying judgment or beliefs about others because of their weight.
Weight bias can cause psychological distress and create stress, anxiety, disordered eating and depression. Physical outcomes of weight bias can include weight gain, negative self-talk, decreased motivation and even binge-eating behaviors (Puhl, Moss-Racusin & Schwartz 2007). Puhl and Brownell (2006) found that eating more was a common strategy for coping with obesity stigma: Seventy-nine percent of study participants reported that they had used this strategy more than once.
The Impact On Client Success
A 2016 review of weight bias research found that, with rising rates of overweight and obesity, “weight discrimination in America has increased by 66% over the past decade and is equivocal to racial discrimination” (Fruh et al. 2016). This bias can severely hinder client outcomes. When clients feel stigmatized or discriminated against, they are at risk for low self-esteem, depression and lower quality of life (Phelan et al. 2015).
Considering that our industry is dedicated to helping people live higher-quality lives by improving their health and fitness habits, it’s unlikely that most trainers are consciously trying to alienate or offend people experiencing obesity. But we also need to recognize that it is, indeed, happening with our clients.
Weight stigma in the gym happens when fitness professionals encourage weight loss goals; make assumptions or judgments about people because of their weight (e.g., assuming, based on body type, that a client will want to lose weight); or make statements about dieting, “earning” cheat days, or achieving “a bikini body” or “six-pack abs” while teaching group fitness classes.
The outward expressions of judgment or “tough love” that coaches sometimes use to shame or blame clients can cause an increase in emotional or binge eating, perpetuating poor health habits and worsening health outcomes over time.
What’s more, clients are unlikely to return to a trainer or coach after feeling judged in a gym or coaching environment, and prospective clients who perceive judgment are unlikely to seek out the help they need.
Where Bias Shows
Weight bias against people with obesity can be explicit or implicit. Explicit bias means there is conscious discrimination. Implicit bias is automatic and often occurs outside of awareness; it can result from the collective ideology of the fitness industry, stereotypes, or lack of personal experience or understanding of the complex etiology of obesity. It can also come from the media, which has been shown to “portray overweight and obese individuals in a stigmatizing manner” (Ata & Thompson 2010).
Examples of collective ideology are gym marketing materials showing only fit body types; fitness facilities promoting weight loss programs with “before-and-after” images, implying that a smaller body is the ultimate outcome; and health and fitness pros holding themselves to a certain hard-to-maintain standard for weight or physical appearance.
But bias can also be more overt: for example, mocking new gym-goers who sign up in January; making judgmental comments to other trainers in the gym about people with certain body types; or perpetuating the idea that individuals with obesity are simply lazy or lack dedication.
So what can be done? A 2005 study noted that beliefs held by a valued group of peers influenced people’s perceptions of individuals with obesity (Puhl, Schwartz & Brownell 2005). This suggests that by focusing on one’s own weight biases, it’s possible to begin to influence peers in the industry.
Acknowledging Personal Biases
“Experts suggest that preventing weight stigmatization and bias is essential to effective obesity treatment efforts” (Fruh et al. 2016). Preventing weight bias and stigma starts with identifying your own personal biases as a health and fitness coach. This can include judgments actively made toward others due to their weight status, as well as behaviors stemming from subconscious ideology—like using specific photos or verbiage on your marketing, website or social media accounts.
Acknowledging your own biases and even your own use of stigmatizing language or coaching tactics can be challenging; admitting that you may have your own underlying personal beliefs is uncomfortable. But it’s worth it. When we learn better coaching techniques, we become better coaches and ultimately help clients have better outcomes.
Working to be more inclusive presents the opportunity to help more people and to have a greater influence on the health of the population as a whole.
Understanding The Complexity Of Obesity
The first step in removing stigma and weight bias from the health and fitness industry is understanding that obesity is a complex disease with many underlying factors and causes. The oversimplification of weight loss that many coaches and trainers subscribe to (“move more and eat less”) tends to blame clients for lacking self-control, being lazy or having “no motivation.” This can lead to weight bias among health and fitness pros and alienate clients with obesity.
The path to improving strength, making dietary changes or losing weight may seem clear to those who have never personally struggled with weight challenges. The common approach to weight loss—“calories in, calories out”—fails to consider the complexity of metabolism, set-point weight and the hormonal impact of dieting over a long period of time.
Factors That Influence Weight
The underlying causes of obesity include a combination of psychological, emotional and physical factors.
A 2018 study found that low socioeconomic status (SES) was a direct link to developing type 2 diabetes mellitus, due to “restricted autonomy and opportunities that could lead to more stress and consequently [an] increase in stress hormones . . . which might ultimately change fat deposition, increasing visceral fat and increasing the risk of T2DM development” (Volaco et al. 2018). Socioeconomic factors include access to food and opportunities or safe spaces for exercise.
Underlying psychological factors can have a big impact on nutritional habits. Clients who grew up with food insecurity (or were raised by parents who experienced food insecurity) can develop eating habits based on a food scarcity mentality. Obeying a food rule like “clear your plate” or eating quickly to make sure you get your share are habits that can develop in childhood and be very challenging to break later in life. Even when there is no shortage of food, underlying psychological factors can be difficult to overcome.
Other psychological factors include emotional eating, binge eating and having been raised by a parent who suffered from emotional eating habits.
Underlying physical causes of weight gain include hormonal and metabolic function, genetics, habits, and ethnicity. Research has linked a history of dieting to weight gain, owing to both the impact of hormonal control of appetite and the role of weight loss in reducing metabolic rate (Dulloo, Miles-Chan & Schutz 2018). Simply put, after weight loss, appetite may increase, whereas metabolism has decreased; this can lead to renewed weight gain.
Sleep has also been linked with weight gain. Shift work can influence weight gain through the disruption of sleep cycles (Sun et al. 2018). Stress can also influence weight, since stress hormones disturb sleep, enhance appetite, trigger cravings and reduce motivation for physical activity (Geiker et al. 2018).
Of course, current nutritional and exercise habits are important, but having empathy for the life experiences of your clients, their deeply rooted habits and their past attempts at weight loss can build rapport and begin to remove weight stigma, improving the coach-client relationship.
See also: Undoing Weight Bias Within Yourself
7 Strategies For Effectively Coaching Clients With Obesity
Blüher’s 2019 report on the epidemiology and pathogenesis of obesity noted, “Lifestyle and behavioural interventions aimed at reducing calorie intake and increasing energy expenditure have limited effectiveness because complex and persistent hormonal, metabolic and neurochemical adaptations defend against weight loss and promote weight regain.” It’s therefore crucial to take a broadened approach to coaching clients with obesity, focusing on overall health habits as opposed to weight.
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